AB1336 EFFECTS OF MUSLIM PRAYER ON LOWER LIMB ENTHESIS ULTRASOUND
Authors: M. Slouma, S. Ben Dhia, C. S. Bellagha, L. Metoui, R. Dhahri, I. Gharsallah, B. Louzir
Journal: Annals of the Rheumatic Diseases (2022)

Background Muslim prayer, also known as salat, includes a series of postures and movements, concomitant with a spiritual meditation and Quran recitations, performed at least 5 times a day by Muslim worshipers [1]. Each prayer includes a specific number of rakaa which consists of a single iteration of movements [2]. Objectives We aim to assess the effects of the Muslim prayer movements on the lower limb entheses, using ultrasonography (US). Methods We performed a cross-sectional study including asymptomatic healthy individuals. Each subject was asked if they performed prayer (G1) or not (G0). People who performed prayer were asked about the age and year when they started praying, number of rakaa performed daily and duration of each rakaa. US of lower limb entheses was performed. We explored the entheses of quadricipital tendon (QT), proximal patellar tendon (PPT), distal patellar tendon (DPT), calcaneal tendon (CT), and plantar aponeurosis (PA) looking for thickening, hypoechogenicity, loss of fibrillar pattern, presence of doppler signal and structure damage lesions (calcifications, cortical irregularity, erosions and enthesophytes). The highest value of enthesis thickness of both sides was considered. Ultrasonographic enthesitis assessment tools were used: the Spanish Enthesitis Index (SEI) [3] and the Glasgow Ultrasound Enthesitis Scoring System (GUESS) [4]. Data analysis was performed using the IBM SPSS software version 26. Results A total number of 370 entheses was evaluated. There were 29 males (78%) and 8 females. The mean age was 44.73±12.7 years. Twenty-five subjects (68%) practice prayer. The mean prayer starting age of 28.58±13.345 years. The mean number of years since prayer was started of 20±16.32 years. The mean daily number of rakaa was 19.16±4.16. The mean total daily prayer duration was 35.28±65.58 minutes. The mean enthesis thickness was 5.98±0.72 mm (QT), 3.69±0.48 (PPT), 4.1±0.64 (DPT), 4.83±0.62 (CT) and 4.89±0.75 (PA). Structural damage lesions were found in 43.2% of subjects (QT), 8.1% (PPT), 13.5% (DPT), 64.9% (CT) and 21.6% (PA). Structure damage lesions of CT enthesis were significantly more frequently found in people who performed prayer (G0: 41.6%, G1: 76%, χ2=4.194, p=0.041). Furthermore, they are significantly more likely to have thickened PA enthesis (G0: 50%, G1: 84%, χ2=4.752, p=0.029). The mean SEI was 17.83 in G0 and 19.56 in G1, p=0.647. The mean GUESS was 18.29 in G0 and 19.34 in G1, p=0.781. A positive correlation was found between total daily duration of prayer and PPT enthesis thickness (r=0.575, p&lt;10-3), DPT enthesis thickness (r=0.362, p=0.028), SEI (r=0.360, p=0.026) and GUESS (r=0.388, p=0.018). Thickness of PPT enthesis was also positively correlated to the number of years since prayer was started (r=0.036, p=0.026). Conclusion Our study showed that lower limb enthesis US abnormalities are frequent in asymptomatic and healthy subjects who perform Muslim prayer. This finding suggests that lower limb enthesis US should be carefully interpreted in these subjects. References [1]AlAbdulwahab SS, Kachanathu SJ, Oluseye K. Physical Activity Associated with Prayer Regimes Improves Standing Dynamic Balance of Healthy People. J Phys Ther Sci. 2013 Dec;25(12):1565–8. [2]Kamran G. Physical benefits of (Salah) prayer - Strengthen the faith &amp; fitness. Journal of Novel Physiotherapy and Rehabilitation. 2018 May 29;2(2):043–53. [3]Alcalde M, Acebes JC, Cruz M, González-Hombrado L, Herrero-Beaumont G, Sánchez-Pernaute O. A Sonographic Enthesitic Index of lower limbs is a valuable tool in the assessment of ankylosing spondylitis. Ann Rheum Dis. 2007 Aug;66(8):1015–9. [4]Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis. 2002 Oct;61(10):905–10. Disclosure of Interests None declared